Despite the hype from Democrats, “the high rate of premature deaths in California and throughout America will continue” even after the Obama health plan is fully implemented, in 2020. “A poverty-level working California citizen… will personally be charged $7,200 for an average hospital stay” – far more than she can afford.

“Even after Obamacare is fully implemented, obtaining affordable health care insurance is likely to still be elusive for at least 5 million Californians and between 80-100 million Americans.”

The U.S. government spends over $2.7 trillion per year (18% of our GDP) on health insurance and care – twice as much per capita as other wealthy nations. Most of the dollars spent on health care go to a private company behemoth that I refer to as the “health care industrial complex.” Despite having the highest per capita health spending rate in the world, at least 75 million Americans still are uninsured or underinsured, and the U.S. still ranks very poorly in international comparisons of quality, outcomes, patient satisfaction, and other measures.

A number of research studies have shown a clear connection between people’s lack of access to quality health insurance and negative effects on the people’s health outcomes.(1) The lack of adequate health insurance can become life-threatening especially when someone is dealing with chronic life-threatening illnesses such as treatable cancer, diabetes, childhood infections and respiratory diseases, and complications from surgeries. According to a study released by the Commonwealth Fund that measured the frequency of mortality amenable to health care in various countries, which is the number of “unnecessary and untimely premature deaths from certain causes that are potentially preventable with timely and effective health care,” the U.S. citizen’s death rate is the highest in the modern world. (2) People who cannot afford the cost of quality health insurance, and other out-of-pocket medical costs, are much more likely to forego or delay life-saving medical care. For example, higher medical costs inevitably motivate some people to skip routine preventive care such as getting colonoscopies, blood tests and other life-saving preventive procedures. People with chronic conditions such as cancer, diabetes, or high blood pressure may also forego services due to the high costs and the chronic nature of their illnesses.

“People who cannot afford the cost of quality health insurance, and other out-of-pocket medical costs, are much more likely to forego or delay life-saving medical care.”

When they forego or delay potentially life-savingmedical care, people’s chances of dying prematurely are significantly increased. The decision to not receive life-saving medical care, which can result in premature death, is most likely to happen when (a) sick people don’t have the financial means to acquire needed medical care and/or prescription medications, (b) medical personnel are unwilling to serve patients without insurance, and (c) people perceive that their immigration status is not considered to be “legal.”

President Obama’s 2010 Patient Protection Affordable Care Act (PPACA) is being marketed as a “great step forward” and a “path-breaking health policy” that will significantly improve the health access of the American people. Democratic Party politicians, and partisan health care advocates, claim the PPACA is a positive step toward making quality health insurance affordable for at least 30 million Americans. Despite these claims, all indications suggest that people will continue to forego or delay potentially life-savingmedical care due to inadequate access to health care. What is most likely to happen is that even after the PPACA is fully implemented in 2020, tens of millions of Americans will not have quality and affordable health plans. These Americans will continue to have difficulty receiving quality medical care when they have life-threatening illnesses, and at least 84,000 Americans will continue to die prematurely each year because they don’t have adequate health insurance for preventive procedures and for medical costs when they get sick. Thus the high rate of premature deaths in California and throughout America will continue, even after PPACA is fully implemented in 2020.

In California a sizeable percentage of uninsured and underinsured Californians forego or delay needed medical care, according to a study recently released by the UCLA Center for Health Policy Research. In 2009, among Californians who are uninsured, 44% forewent or delayed attending to their medical needs during the entire year. Among those who had employment-based coverage, 25.4% forewent or delayed attending to their medical needs. (3) According to the same study, the California version of PPACA’s insurance “Exchange” is expected to offer federally subsidized, quality health insurance policies to approximately 1.63 million of our citizens: roughly 533,000 Whites, 823,000 Latinos, 113,000 Blacks, and 164,000 Asians.

“All indications suggest that people will continue to forego or delay potentially life-saving medical care due to inadequate access to health care.”

The federally-financed, State-run PPACA insurance exchanges are the vehicle that is supposed to improve health care access for people who earn up to 400 percent of the federal poverty level ($88,200 for a family of four), and who don’t already have Medicare or Medicaid. These people will be eligible for subsidies to help make insurance premiums more affordable. The State-runinsurance exchanges will offer four types of Plans that offer four levels of coverage, based on “actuarial value.” Actuarial value is a measure of the level of protection a health insurance policy offers and indicates the percentage of health costs that, for an average population, would be covered by the health plan. Enrollees (on average) would have to pay for the insurance (usually with help from government issued “vouchers”) AND pay 10% - 40% (or more) of their own total medical costs when they are hospitalized. (4) The four Plan types provided in PPACA “exchanges” are: Bronze Plans that pay 60% of hospital bills; Silver Plans that pay 70% of bills; Gold Plans that pay 80% of bills; and Platinum Plans that pay 90% of bills.

It is expected that “[t]he benefits of the four plan types [offered in the State-run “Exchange”] will be similar; all will cover a package of comprehensive essential health benefits.” However the specific packages of “essential” benefits are yet to be determined by the federal secretary of Health and Human Services and by each State. For example, if California devises a State Exchange Plan similar to the one established in the Oregon State “Exchange,” there will be additional costs for “supplemental” coverage, for access to health services such as “pediatric vision, pediatric dental, prescription drugs and habilitative services.” (5)

These four Plan typesactually guarantee inequality of access to affordable health care among Americans. Why? Because each of the four Plan levels makes different cost-sharing demands on the persons who can afford them; and the Plans are particularly harsh on the most disadvantaged Americans. For example, at least two of these Planswill not provide many of the neediest citizens with access to affordable high quality health care services. When California workers who own subsidized Bronze or Silver insurance Plans have to spend time in the hospital, their family’s cost-sharing responsibility will be 30% or 40% of the total bill. People with chronic conditions such as cancer, diabetes, or high blood pressure will have even higher costs due to the chronic nature of their illnesses. (6)

A recent article in the Los Angeles Times reported that in 2009, the “Cost per day for hospital charges averaged $3,949 in the U.S.” (7) Considering that the average length of a hospital stay (ALOS) in the U.S. in 2009 was 4.5 days, according to data provided by the Organization for Economic Co-operation and Development (OECD), and the average cost per day was about $4,000, the typical hospital patient would owe about $18,000 for hospital expenses by the time they were released. (8) Poor working Californians who can only afford a Bronze Plan (even with the subsidy “vouchers”) will be expected to pay 40% of their total hospital bills. This means a poverty-level working California citizen who can afford a Bronze Plan, and whose average gross annual income of $9,697 already is stretched to the very maximum, and who then incurs a medical bill of at least $18,000, will personally be charged $7,200 for an average hospital stay, despite the fact that for very poor people, even a $1 or a $3 co-pay can be a barrier to care. (9) This concrete example of unaffordable medical costs shows how many of those 1.63 million Californians who are eligible for the Bronze and Silver levels of subsidized health insurance coverage under the PPACA could fail to get affordable care when they get sick.

Then there is the problem of the actual Out-of-Pocket expenses associated with a chronic illness. Inevitably these expenses will be an added burden due to the ongoing charges for medicines and so forth. According to federal National Health Expenditure projections over the next 10 years, Out-of-Pocket expenses to citizens are “expected to grow faster through 2013, reaching 3.9-percent growth, as disposable personal incomes increase and employers continue to shift more of the cost of health insurance to their employees. Out-of-pocket spending is projected to grow at an average rate of 5.0 percent [each year] from 2015 through 2020. (10)

The bottom line: Even after Obamacare is fully implemented, obtaining affordable health care insurance is likely to still be elusive for at least 5 million Californians and between 80-100 million Americans. The high costs to citizens for medical coverage will continue to motivate some people to forego or delay attention to their medical problems. We will continue to read studies and stories about people who died because they did not seek medical help in a timely fashion, or could not afford medications, or who ignored headaches or chest pains because they did not want to pile up debt/costs from doctor visits.

“Neither the Democrats’ Health Insurance Plan (Obamacare) NOR the Republican’s Romney’s Plan or 'Ryan Plan' are good for the country as a whole.”

Recent estimates from the U.S. Congressional Budget Office are that well over 30 million people will remain completely uninsured. Further, estimates are that another 40+ million people who have an insurancepolicy, still will be under-insured (i.e. will not have enough coverage to meet their medical needs) because of (a) the limitations and inequities inherent in the four insurance Plan types available through the State Exchanges, (b) ever-increasing costs for health insurance coverage - costs that don’t keep pace with wage increases, and (c) the expansion of employer-sponsored high cost and/or high-deductible plans. The reality of being “under-insured” likely will be the new normal. (11, 12, 13) And millions more Medicaid-eligible citizens may not have insurance available to them because of the opt-out provisions that are likely to be exercised by some States.

A big disadvantage of discussing health care policy in an election year is that the truth is hard to come by. Lest some people try to portray my remarks in this article as critical exclusively of the Obamacare Plan, let me saystraight away that neither the Democrats’ Health Insurance Plan (Obamacare) NOR the Republican’s Romney’s Plan or “Ryan Plan” are good for the country as a whole. Good for some? Surely. Good for most? Hardly. Although each of these Plans may have some distinctly positive features, ALL of them are designed in ways that will lead to the deaths of 10s of thousands of Americans every year and will likely leave over 70 MILLION Americans hurting financially due to medical debt.

Most advocates for the reigning government Plan (Obamacare) will readily acknowledge that "it isn't perfect." That is a gross understatement. What they will NOT say, because of their partisanship, is that Obamacare is extremelyimperfect. No one should be happy with, or “support” a health care "solution" that forces thousands of American people to die each year due to the high cost of quality health care. The America I learned to champion is a place where ALL men and women are created equal, and deserve life, liberty and the pursuit of happiness. I am not happy with an America that rationalizes inequality of access to life saving health insurance under the guise that "something is better than nothing." If there is “humanity” in that, it is incomplete. I prefer “healthcare liberty, justice and equality for all.” That's just me.

Dr. Reginald Clark is co-chair of the Education Program Committee for Labor United for Universal Health Care, a coalition of over 50 unions and labor-allied organizations, as well as individual activists whose mission is to establish a sustainable, secure, and just healthcare system through education, mobilization, and advocacy within the Labor Movement and beyond. Also, he is a lecturer in Child and Family Studies at California State University, Los Angeles.

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